Young Adult With Upper Abdominal Pain

A 19-year-old man with no medical history presented to the emergency department with right upper quadrant abdominal pain 2 hours after being elbowed in the abdomen during a soccer match. Review of systems was pertinent for nausea and vomiting. Pulse rate and blood pressure were within normal limits. Physical examination was notable for right upper quadrant abdominal and right flank tenderness. Laboratory results were notable for a normal CBC count, comprehensive metabolic panel, and urinalysis. The emergency physician performed bedside ultrasonography, which showed hydronephrosis and perinephric fluid (Figures 1 and 2).

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